Comparison of the clinical effectiveness and safety between the use of denosumab vs bisphosphonates in renal transplant patients.

A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; at years 1, 2, and 3; and at final follow-up (average of 3.4 years). Both bisphosphonate and denosumab treatments increased lumbar spine bone density; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Denosumab treatment increased femoral neck BMD, whereas bisphosphonate treatment had a mean decrease in femoral neck BMD at final follow-up. Thus, our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant. INTRODUCTION: To compare the clinical effectiveness and safety between the use of denosumab and bisphosphonates on bone density and incidence of adverse events in renal transplant patients. METHODS: A retrospective chart review was conducted on 85 renal transplant patients aged 19-88 years, treated with denosumab or bisphosphonate therapy. Bone densitometry measures were compared between treatment groups at baseline; years 1, 2, and 3; and at final follow-up (average of 3.4 years). RESULTS: Absolute change in lumbar spine and femoral neck BMD over the treatment period was 0.029 ± 0.075 g/cm2 and - 0.003 ± 0.064 g/cm2, respectively, in the bisphosphonate group. Absolute change in lumbar spine and femoral neck BMD at final follow-up was 0.072 ± 0.094 g/cm2 and 0.025 ± 0.063 g/cm2, respectively, in the denosumab group. Denosumab resulted in significantly greater increases in lumbar spine BMD (0.045 g/cm2 greater in the denosumab group). Similarly, the absolute change in BMD at the femoral neck was 0.022 g/cm2 greater in the denosumab group as compared with the bisphosphonate group. The denosumab group had one event of severe hypocalcemia following first injection and one report of hospitalized pneumonia. No serious adverse events were reported in the bisphosphonate group. CONCLUSIONS: Both treatments increased lumbar spine BMD; however, the effect of denosumab was greater compared with that of bisphosphonate treatment. Our study provides evidence for the efficacy of denosumab treatment in renal transplant patients. Caution around hypocalcemia is warranted. We recommend more prospective studies to analyze the effects of long-term antiresorptive therapy in patients with a renal transplant.

Correction to: Comparison of the clinical effectiveness and safety between the use of denosumab vs bisphosphonates in renal transplant patients.

The original version of this article, published on 03 January 2020 contained a mistake. An author's name was misspelled.

Relative hypoparathyroidism and hypoalbuminemia are associated with hip fracture in hemodialysis patients.

AIMS: Patients with end-stage renal disease treated by hemodialysis are at an increased risk of hip fracture. In the general population, hip fractures are associated with increased morbidity and mortality. The objective of this study was to assess the predictors and outcomes of hip fracture in the hemodialysis population, including quality of life post hip fracture. METHODS: A case-control study from 1999 to 2005 included 29 adult hemodialysis patients with hip fracture and 55 controls, matched on age, gender and number of years on hemodialysis. A logistic regression model was used to derive predictors of hip fracture. The association between time to death post hip fracture and parathyroid hormone was analyzed using a Kaplan-Meier curve. The ability to live independently 1 year after hip fracture was used as a measure of quality of life. RESULTS: Variables associated with hip fracture were a reduction in serum parathyroid hormone by 100 pg/ml (OR = 1.65, 95% CI 1.10, 2.46) and a decrease in serum albumin by 1 g/l (OR = 1.18, 95% CI 1.00, 1.39). 40% of the cases died within the first year post hip fracture. Median survival time in patients with hip fracture and a serum PTH value < 100 pg/ml was 17 days (95% CI 0, 37 days) as compared with 280 days (95% CI 103, 471 days) for those with a PTH value > 100 pg/ml (p < 0.02). Among the patients who survived, 53% were subsequently discharged to a long-term care facility. CONCLUSIONS: Relative hypoparathyroidism and hypoalbuminemia are associated with an increased risk of hip fracture in hemodialysis patients. There is also a significant reduction in quality of life in patients sustaining a hip fracture.

Benefit of continuous renal replacement therapy in subgroups of acutely ill patients: a retrospective analysis.

AIMS: Acute renal failure in the intensive care setting is common and impacts on patient's outcome. Continuous hemodialysis or hemofiltration offers theoretical benefit for patients with acute renal failure, but the clinical benefit has not been demonstrated in randomized trials. ICU patients with acute renal failure are a heterogeneous population and we hypothesize that patients with increased illness severity would benefit from continuous renal replacement therapy. METHODS: From a comprehensive ICU database, we identified patients with acute renal failure exposed to continuous or intermittent renal replacement therapy. We a priori identified a subgroup of patients with multiple organ dysfunction syndrome, then used survival analysis to assess the effect of dialysis modality in the overall acute renal failure population and in the subgroup with increased illness severity. RESULTS: We identified 66 patients treated with intermittent and 36 patients treated with continuous renal replacement therapy. Patients with severe illness were preferentially selected for treatment with continuous dialysis (p = 0.01). Overall, there was no significant difference in survival between patients treated with intermittent or continuous dialysis. The relative risk of in-hospital mortality was significantly decreased in patients with multiple organ dysfunction syndrome (relative risk = 0.42+/-0.22, p = 0.027) treated with continuous therapy as compared with intermittent therapy. Among the survivors, continuous dialysis did not appear to hasten the return of renal function. CONCLUSIONS: This retrospective study suggests that continuous dialysis may be beneficial in a subgroup of ICU patients with multiple organ dysfunction syndrome or severe sepsis. Further randomized trials of dialysis modality should, if possible, concentrate on this population.

Liver-kidney transplantation in primary hyperoxaluria type-1: case report and literature review.

Primary hyperoxaluria type-1 (PH1) is a rare inherited autosomal recessive disorder in which a deficiency of the hepatic enzyme alanine-glyoxylate aminotransferase leads to endogenous oxalate overproduction, renal failure, systemic oxalate deposition and death. As hemodialysis provides insufficient oxalate clearance, patients ultimately require both liver and kidney transplantation for correction of the metabolic abnormality and oxalate excretion. Herein, we describe a young adult male with end-stage renal disease and systemic oxalosis causing progressive disabling multi-organ dysfunction while awaiting transplantation. We review the literature regarding liver-kidney transplantation and suggest that for patients with PH1, a standardized assessment of organ dysfunction and functional impairment may improve identification of patients requiring urgent transplantation thereby reducing the morbidity and mortality that can occur with delayed transplantation.

Endometrial biopsy: a pilot study of instrument used; Pipelle vs infant feeding tube.

A small pilot study to compare the use of infant feeding tubes (IFT) for endometrial biopsy compared with the standard Pipelle tubes was calculated. We assessed patients' pain scores and the number of successful samples obtained. This study highlights that an IFT may be more comfortable for the patient and be equally as effective at obtaining an adequate biopsy sample but a larger randomised study is needed to explore this further.